It's Not an Either/Or Situation

    Lately, I've been seeing some things online that tell people with mental health conditions that if they just eat the right foods and make the right lifestyle changes, they won't have to take their psychotropic medications anymore. I've seen things that suggest anxiety can be cured using only meditation. I've seen things on social media that tell people on antidepressants that the only antidepressant they really need is to spend some time outdoors and get some exercise. I find this attitude more than a little troubling. 

   I know there is a stigma associated with mental health in general, and that their is a particular piece of that stigma that tells people they should feel embarrassed or ashamed if they have to take medications to help balance out their brain chemicals. I know, especially recently, with the rise of the "back to the earth" movement among younger generations, natural remedies for ailments are pushed pretty heavily. That's fine. Natural remedies can work for SOME things. What isn't fine is that society treats medication, especially for "invisible" conditions like mental health conditions, and natural remedies as sort of an either/or situation. As in you're either doing things the "wrong" way and taking the medications, or you're doing things the "right" way and stopping the medication for the old-fashioned natural approach.

    Natural remedies, as I said before, can work for SOME things for SOME people. The lifestyle changes and natural remedies can be good for helping manage the day-to-day symptoms of some conditions like anxiety and depression, but they don't treat the underlying issue of the imbalanced brain chemicals. Only medication and therapy can work to treat the underlying issues of imbalanced chemicals and faulty thought patterns that come with the out-of-balance brain chemicals. It isn't an either/or situation. At best it's an AND situation between medication and lifestyle and/or diet changes that a person can afford or is able to make.

    I get it. Many people don't like taking medication every day, especially not if it's something they may have to take for the rest of their life. Psychotropic medications, like all medications, can come with nasty side effects. The trial and error process of finding the most helpful medication in the correct dosage can be tedious and discouraging, especially when someone is in emotional distress or is otherwise significantly impaired by the mental health condition. I also get that medications are expensive. So of course, a great many people will be grasping at whatever could work to get off the medication in favor of something "easier" and less expensive. Of course, if some change or natural remedy worked for you, you might be tempted to push your friends to go off meds and try the thing that worked for you instead.

    But...let me explain why that's not a great idea. Many people need their medications to be functional and to stay alive. No amount of exercise, diet changes, lifestyle changes, or supplements in the world can replace the medication. That is okay. Also, those people, no matter how much they love you and want to make you happy, are not obligated to risk their jobs, mental stability, and lives to try the remedy that worked for you. I know it can be tempting to look for an "easier" (as in easier to access or tolerate or talk about) way to help your brain, but nobody should ever go off their medication unless their psychiatrist tells them it's time to stop the medication. 

    I'll end with this: I know I talk a lot about the lifestyle and diet changes I made to help improve my life with OCD and panic disorder and that I also talk a lot about taking L-theanine and CBD products instead of taking medication. That doesn't make me anti-medication. It should never be medication OR natural remedies, lifestyle changes, and diet changes. It should be medication AND natural remedies, lifestyle changes, and/or diet changes depending on the changes someone is able to make. Lastly, and I can't emphasize this enough, if you are taking medication, PLEASE DO NOT stop your medication in favor of a "more natural approach to treatment" because someone who is not on your mental health team wants you to/because it worked for them/because it's "better"/because it works faster, or any other reason.

The Bad Days

    Often, unless I've been full-on panicking, when my therapist asks me how I am at the beginning of a session, I'll say, "Eh. I'm fine." Then she'll reply, "Like actually fine, or the kind of fine where you're about to tell me all the reasons you're not actually fine?" (A lot of the time it's the second "fine".) 

    I don't like talking about my bad mental health days. Even after four years and eleven months in therapy, my knee-jerk reaction to a bad day is to act like it's a dirty little secret. Part of it is because I'm naturally a very private person. Part of it is because I have a hard time trusting other people with such "valuable ammunition" like information about my bad mental health days. Part of it is still the mental health stigma that is woven into our society, like the unwritten rule in our (American) society that tells us that people aren't going to want to "put up with us" if we show symptoms of a mental health condition. It actually took me a couple of YEARS to be able to tell my best friend when I was having a bad day with my OCD despite the fact that we talk almost every day, because I was afraid she wouldn't want to deal with all my nonsense. (She doesn't think it's nonsense, and she's a good member of my support system.)

    I also had this idea, at the start of my journey with mental health counseling, that once I had spent enough time in therapy that I wouldn't experience bad days any more. I thought I'd go in, work on my OCD, and then my brain would be "fixed" enough so that I wouldn't have any more really bad days. So, you can imagine my frustration when the bad days were still (less frequently) happening one year into therapy, two years in, three years in...I thought I'd be "better" after all that time. I thought healing meant that the bad days would magically disappear. That idea made it feel like I was failing every time I had a bad day, so of course I treated the "failures" like a dirty little secret.

    I have since learned that bad days are a permanent part of living with a chronic health condition, like mental health condition. They may happen less frequently, but at some point, a bad day will happen, and that's okay. A bad mental health day isn't a failure. It's just a bad day, like the days you wake up and the knee you sprained six years ago is aching for some unknown reason, and so you manage the pain as best you can and be extra careful with your knee that day. It doesn't mean you aren't healing properly, it just means that day is one in which you need extra care.

    As permanent events in life with a mental health condition, bad mental health days need to be acknowledged and accepted. Yes, it's unpleasant, but acknowledging that it's happening and that it'll happen again at some point takes away some of the power the bad day has to make you feel even worse about the fact that you're having a bad day. It's just a bad day, not a personal failure or a dirty little secret, and it's only temporary.

    I'll end with this: If you're a very private person, like me, it can be extremely difficult to let people in, especially to be able to talk about anything personal, like the details of a mental health condition. Bad mental health days aren't a dirty little secret or a personal failure. They're a permanent event in life with a mental health condition, and that's okay. Despite what the mental health stigma tells us, it's okay to have bad days and to show symptoms, and it's also okay to talk about it while it's happening or after it happens.

Anxiety Isn't a Code Word

    As someone with two diagnosed anxiety disorders, anxiety is pretty much my constant companion. I check in with my anxiety often so that I'm always mindful of how I'm feeling and treating myself, and I usually manage it pretty well. But, then, there are just some things that happen, or some places, or some people that can be a trigger for my OCD and/or Panic Disorder. 

    As someone with Panic Disorder, crowds, like those we usually find in stores before the holidays, or those generally swarming the streets of Gatlinburg can trigger a panic attack. Over-stimulating environments, like if the environment is really loud or there are a lot of flashing lights, or if people are yelling can trigger a panic attack. Wearing a mask when I go out is also a thing that can trigger a panic attack, as is having a stuffed up nose. (I still wear a mask.)

    As someone with OCD, change of any kind is a huge trigger for me. Any change in my daily routine, and especially bigger changes in my life like moving, cause a spike in anxiety that will then cause a spike in the occurrence and volume of my intrusive thoughts. Even happy changes, like unexpectedly being invited somewhere or unexpectedly having someone I like drop by for a visit is enough to cause a spike in my anxiety, because that is a deviation from the day's routine that I had planned out the day before.

    Here's the thing though: "This is messing with my anxiety," isn't code for, "I don't want to do this" or "I don't like this". Just because something makes me anxious doesn't mean that I don't WANT to do that thing. It doesn't mean that I don't LIKE doing that thing. Just because something could make me anxious doesn't mean that I won't TRY TO ENJOY the thing. Just because I'm anxious when someone drops by for a visit unexpectedly doesn't mean that I don't want to see them or that I don't want them to come over. Sure, I wish they had called or texted first, but, I'm still probably happy to see them. (I'm an introvert, so I'm not above just not opening the door and/or hiding until they leave if I REALLY didn't want to see them. I would also just decline an offer if I didn't want to do something.)

    Here's what that does mean: I may have to work a little bit harder to be able to do the thing. It may take me a little bit to work up to doing whatever the thing is, especially if I've already had a panic attack doing that thing or a similar thing before. (Example: I had a panic attack in the movie theater once, and it took me a couple of months to be able to go back to the movie theater.) I also probably need a small adjustment period to get used to the unexpected change even if it's a nice change. I mean, my brain is more than likely screaming at me, "This wasn't the plan. This feels different. DANGER! ABORT MISSION!" So, I'm going to have to work on quieting that anxious voice, which may take a few minutes. It also means that some days the trigger may feel too intense or my anxiety may already be too high, and I may have to leave or cancel doing whatever thing it was.

    I used to feel guilty, ashamed, or angry when I experienced an OCD spike or had a panic attack when I was TRYING to enjoy something. It almost felt like making excuses to admit that something was negatively affecting my anxiety disorder. I try not to be so unkind to myself these days. I had to stop and recognize that making my mental health a priority was actually listening to my body and acting accordingly. Sometimes, that just means talking to myself with extra compassion and patience while I still try to enjoy a place, event, or people; and sometimes that means recognizing that I need to step away to bring myself back to a better place before I can truly enjoy something or embrace a change in routine.

    I'll end with this: Experiencing mental health symptoms doesn't mean that someone doesn't want or like doing something or being somewhere. It may just mean that someone needs extra compassion and understanding to work through the symptoms or that they need to gracefully bow out this time. That is okay. Saying something is triggering a mental health condition also isn't a code for "I don't want to do/don't like this." No one should feel guilty, ashamed, embarrassed, or angry for prioritizing mental health in this way.

In My Box of Tools

    If you've read my blog for any length of time, I'm sure you've heard of my "box of tools". This is the imaginary place where I keep all of the helpful ways I manage my anxiety. (I've seen other people call it a mental health crisis kit or a mental health self-care kit, but I just like the imagery of a big box of things that I can sort through.) I know I've talked about the coping strategies, meditation, the diet changes, and the exercises (like yoga for anxiety) that are inside my "box of tools", but my box actually has a bit more stuff in it. I thought I'd share the complete list of contents of my "box of tools" in case anyone was wondering how to build their own.

MUSIC:

    Music plays a big part in how I manage my day-to-day anxiety, so I try to make sure I always have access to music whether it's on my laptop, on my phone, or on my iPod. It doesn't have to be the meditation or relaxation music, either. It can be any kind of music that you find comforting or that you find makes you smile. I have a friend that uses ASMR to relax.

    I, on the other hand, prefer listening to All Time Low when I'm anxious. Traditional meditation and relaxation music tends to grate in my ears, and I find that unpleasant. Something about the heavy drums and guitar relaxes me out. It's like I can feel the tension and anxiety melting out of my body, and I feel like I can actually breathe. A lot of the time, just listening to  a couple of All Time Low songs brings my anxiety down to a manageable level so that I don't need to take any supplement to reset my brain.

MOVIES, TV, and YOUTUBE:

    There are a couple of VlogBrothers videos on YouTube in which John Green talks about his mental health, and those videos always give me a renewed sense of hope. (I've made a couple of posts about a couple of the videos in the past.) I find that those videos always make me feel at least a little better. 

     I also keep my favorite TV show and my favorite movies in my "box of tools". Sure, it doesn't really "fix" anything, but sometimes, all your brain needs is a few moments of distraction from the anxiety so it can stop trying to pile more anxiety on top of the existing anxiety. Plus, watching my favorite TV show or my favorite movies gets me out of my head and into the present for at least an hour or so, and it stops me from thinking about how awful the anxiety feels or how loud the intrusive thoughts are on that day. 

COLORING BOOKS:

    When my brain feels like it's going too haywire for me to use mindfulness meditation, I like to color. I learned in a class that, for adults, the brain treats coloring like a sort of meditation, so sometimes I have to substitute. So, if sitting still and focusing on your breathing isn't for you, I recommend coloring. 

THE ROSARY:

    At the point I'm reaching for my rosary, it's been a REALLY rough day. I've been crying. I can't focus on anything. I probably haven't been able to eat much. Nothing else has worked so far. 

    I find praying the rosary peaceful, even if I no longer consider myself Catholic. The clinking the beads make as I move along the decades, the feel of the beads in my hand, the concentration it takes to keep track and say the right prayer on the right bead, the concentration of thinking about the Mysteries...all of it just add up to a peaceful, hands-on meditative experience for me. It's another tool that enables to me to literally feel the anxiety and tension leave my body. (Note: You don't have to be Catholic to pray the rosary. Anyone can do it if they want to.)

SUPPLEMENTS:

    I've never felt like my anxiety was severe enough so that I needed to take an actual anti-anxiety medication every day, and my therapist agreed. I've just needed to take something occasionally to help bring it to a manageable level after a spike or to prevent the (now) occasional panic attacks. So, my therapist worked with me to find some supplements for my "box of tools" that I could take as needed. I typically use these if nothing else I've tried has worked.

1. L-Theanine Capsules: L-Theanine is a compound that occurs naturally in green and black tea. In the concentrated capsule form, this compound works to noticeably increase the brain waves that help us feel calm and focused. I take one of these when I need a "soft brain reset", and I can usually feel the drop in my anxiety within an hour. (This supplement is not recommended for regular use by people with depression as it increases the brain waves that can worsen depression. It can also lower blood pressure so it isn't a good idea if you take blood pressure medication.)

2. CBD Candy: Yes, CBD products are the "new" hemp products that everyone keeps talking about. I was surprised when my therapist suggested I try a CBD product, and I was equally as surprised by how quickly and how well it actually worked when I tried it. I take one of these when I need a "hard brain reset", and within half an hour, I feel a little wonky but fine. These have a much stronger effect than the L-Theanine, and the effect lasts longer. Since I no longer have access to Ativan, I use these instead. (It didn't have to be candy. There is a CBD oil, but I chose candy because I wanted something that tasted good for once, and it looked a bit more fun.)

**Note: I'm not saying anyone should stop taking their prescribed medications in favor of a more natural approach. I'm also not saying that these supplements are a good idea for everyone. If you need medications, please, take them, and if you're thinking about trying supplements, talk to your mental healthcare team first.

SNACKS:

    This might sounds silly, but I keep small snacks around as part of my "box of tools". I keep small squeezable applesauce packets or small packs of crackers in my backpack pretty much all the time. I also keep small snacks in my room. I do this because, when I'm anxious, I don't eat, and if I'm really anxious, I will literally gag on food when I try to eat. So, I keep small snacks like applesauce and crackers because I can always take a few bites and put it away. Then I can take a few more a few minutes later. If I eat something small like that, I'm less likely to gag on it, and I'm still getting something to eat, which is the main idea.

    This idea works for any small snacks, I just like applesauce, and I like Ritz crackers. Some people eat just a piece of sandwich meat or something else small. The idea is just to eat SOMETHING.

    I'll end with this: It's a good idea to have some helpful things tucked away that you can use to cope on those bad mental health days. It doesn't just have to be ONLY things you learned in therapy. It can be anything that brings a sense of comfort or helps you manage symptoms. Each person's "box of tools" is personal, and that means that your "box of tools" doesn't have to look like anyone else's. All that matters is that you find HEALTHY ways to make yourself feel a little bit better on those bad days.

Letting Go of "What If...?"

     What if I really am a terrible person? What if my cat thinks I don't love her because I wouldn't let her sit in my lap that ONE TIME today? What if I die in my sleep because I took my allergy medications AND an Ibuprofen? What if my heart really does just give out during a panic attack? What if I actually get Covid-19, and I die? 
     My brain has always been great at asking "What if?" questions like the ones above, and I've always been super great at sending myself into an anxious frenzy with the questions my brain likes to ask. Honestly, one minute everything is fine. Then my brain tosses out a question like the ones above, and before I know it, I've spiraled. Thinking of one "What if?" scenario leads to thinking of more and more terrifying worst case scenarios. Then, I'm crying while I'm trying and (sometimes still) failing to pull myself back from the edge so I don't tip over into a full-on panic attack.
     Yes, thinking of the future and having an idea of the things you want is a good idea, and being prepared for some mishaps is a good thing. Here's the thing with the "What if?" questions, though. They're never positive, are they? It's always something like, "What if X goes wrong?" And it's never, "What if X goes well?"
     On top of always being a worst case sort of thing, they take us into the future, and the future is always full of uncertainty. An anxious brain doesn't do well with uncertainty. So, of course, my anxiety skyrockets when those types of questions are asked because I can't say for sure that everything will be okay. (I can't say for sure it won't be okay, either, but my brain doesn't pay attention to that idea.) Then, in an effort to cope in a backwards sort of way, my brain gives me more and more worst case scenarios so I can think about how to handle them.
     Then I have to go to my therapist, and I have to tell her that I practically caused myself to panic. She understands. She tells me the same thing she always tells me: that I have to let go of the "What if?" and live in the current reality. Every "What if?" question I bring her, she asks something like, "What evidence do you have?" Then when I can't think of any evidence to support the worst case scenario zipping around in my brain she asks something like, "So, what's the currently reality of the situation?" Then I basically end up telling her that everything is (mostly/sort of) fine, and that I'm just anxious.
     I've been working on this pretty much the entire time I've been in therapy. It isn't easy. I'm a planner. I'm future-oriented. I've been working on it more with the current situation in the world. Every time I start to hear the "What if?" sneaking in, I have to stop myself. I have to stop and say, "Well, currently, X, Y, and Z are fine, and that's all I have to worry about right now." Or, I have to ask myself, "What is the evidence?" When I (usually) can't come up with any, I just take some deep breaths and try to move on. Some days, this is easier to do than others, but at least I'm working on it.
     I'll end with this: Learning to live in the current reality without asking "What if...?" is difficult, especially for those of us with anxious brains. But...those future what if's are dangerous, friends. When we only live in the uncertain future, we can miss all the things in the current reality that actually are okay and that can offer us some sense of certainty and stability, which we all need to thrive. 

The Weight of the World

     I've always wanted to help people, to put good out into the world and maybe make the world a little bit better for at least one other person. I didn't always know how I wanted to put good out into the world and help people, but I was always sure that was something I wanted. I mostly definitely never wanted to cause anyone harm. I was the kind of person that was full of guilt and remorse if I even snapped at somebody, and I'd beat myself up over it for a long time afterward, even after all had been forgiven.
     Then my intrusive thoughts started happening, and they were the worst possible thoughts I could have, at least to me. They were blasphemous in nature. I just knew God was going to be so angry. I just knew I was going to be divinely punished, and that the punishment that I deserved was the worst punishment possible. This idea also lead to the thought that everything bad that happened in the world, (natural disasters, health crises, large-scale traumatic events...literally everything on a grand scale that hurt other people) had to be my fault because of the intrusive thoughts.
     I know that sounds weird, right? Here's how I got there: I wanted to help people so much and to put good out into the world so much that, of course, the best way to punish me for my intrusive thoughts was to do something to hurt other people because that would hurt me the most. So, of course my divine punishment would have to be to cause bad things to happen to people and to cause suffering because that was the exact opposite of what I wanted. (I know that makes no sense, but mental illness never makes sense, does it?) Every time my therapist and I would take about this, she would point out how irrational it was, how impossible it was. She would also remark that I didn't need to carry the weight of the world on my shoulders.
     Then the current health crisis struck, and it quickly turned into a global event. I'm worried about it, of course. I'm worried about the blatant disregard I see from some people for the health and safety of others. I'm worried about becoming ill. I'm worried about my mom becoming ill. It's been the topic of my phone therapy sessions for weeks.
     I was actually in a phone session with my therapist when I realized something unexpected. I didn't think this global health crisis was my fault. The idea that it could be my fault hadn't even occurred to me. Yes, I'm anxious, but I'm anxious in much the same way other people are anxious during this time. For the first time in my adult life since I've had OCD, I hadn't just assumed this terrible thing was my fault. And then to realize that the idea that had lived in my mind for so long was so far gone that it hadn't even occurred to me? I could have cried happy tears.
     At some point over the last three years or so, I had finally stopped carrying the weight of the world, so to speak, and I didn't even realize it. It's the progress that I'm most grateful for right now. I'm also grateful that I was able to take a moment to recognize how far I've come since I started therapy almost five years ago.
     I'll end with this: Our mental health conditions can make us think some cruel and irrational things. I know it's hard, but don't believe everything you think. Also, progress might not come in quickly recognizable moments, but it's still progress. It's okay to take a moment when you do realize you've made progress just to sit with it and feel grateful for it.

Cooking Around My Anxiety

     I know I talk a lot about the lifestyle changes I made to have a better co-existence with my anxiety disorders. One lifestyle change I made that I don't often talk about is the way that I eat. I practically did a diet overhaul. I've learned over the years since my diagnoses to cook around my anxiety. (It happened a little bit on purpose, but also a little bit by accident.)

     That sounds weird, right? Let me explain. When I have been experiencing prolonged low to moderate anxiety or if I am experiencing the spike in my anxiety symptoms that comes with my monthly hormone fluctuations, I tend to eat more of certain foods because they make me feel better, and I find them comforting. I'll have avocado toast for breakfast more often. Then for dinner, I might cook some salmon, lamb chops, or some black beans, or I might make a recipe that includes a turmeric-heavy seasoning blend that I make myself when I feel like I need the extra boost of comfort. (Turmeric makes me feel so relaxed and happy that I could curl up and purr like a cat. That's totally not weird, right?) As a person who loves food, I thought I just had a strange list of comfort foods.

     I had been doing this for a year or so, and I kept taking it to my therapist. She always asks what I do when my anxiety spikes or is up for a prolonged period of time. I'd tell her I cooked something, and how that food made me feel less anxious. So, then she would bring up the whole brain-gut connection, and she would explain that what we eat has the potential to impact how we feel physically and mentally. A local nutritionist also recently repeated the same thing.
     I wanted to know more about this gut-brain connection so I started looking into it. I found a post on the Harvard Health blog by Dr. Uma Naidoo, a nutritional psychiatrist and faculty member at Harvard Medical School (links at the bottom of this post). In her blog post, she talks about nutritional strategies to ease anxiety. She mentioned that foods high in Omega-3's, like Alaskan salmon had been shown to help reduce anxiety, and that zinc from red meat like beef (or lamb), could also help reduce anxiety. She also lists foods high in B Vitamins, like avocado as anxiety-reducing foods. Dr. Naidoo explained that these foods were sort of "feel-good" foods that triggered a release of dopamine and serotonin. Turmeric was also listed as a spice that had anti-anxiety properties.
     Dr. Naidoo also mentions that foods high in antioxidants, like black beans, fruits like blackberries, raspberries, and plums (which are three of my favorite fruits to snack on), and vegetables like broccoli (which I have at least once a week) and spinach might assist in lowering anxiety as well.
     It turns out that pretty much all of my comfort foods were on Dr. Naidoo's list. Without even realizing it, I had been using an anti-anxiety diet to help manage some of my anxiety. I'm not saying that following an anti-anxiety diet "fixed" anything going on in my brain. I'm just saying that certain foods made me feel better and less anxious after I added them into my diet more often, and I later found out that studies had shown those foods were helpful in managing anxiety. I'm also definitely not saying a diet change should replace medications and/or therapy. I'm just saying it wouldn't hurt to have another tool in your tool kit to try out.
     Now, I understand (at least a little bit), and I cook that way intentionally. The diet piece of the puzzle feels like another tool in my imaginary anti-anxiety tool kit that I can use all the time without having to worry if it'll eventually become ineffective. I know it seems like a weird idea to cook "around" a mental health condition, but people do it all the time for other health conditions like acid reflux, diabetes, and autoimmune conditions. Cooking to help your brain chemicals shouldn't be any different.
     I'll end with this: I'm not saying that eating certain foods will cure a mental health condition, but studies have shown that certain foods CAN help manage the day-to-day symptoms of mental health conditions like anxiety and depression. People change diets to help manage all sorts of physical health conditions all the time, and changing a diet to help manage a mental health condition should be taken just as seriously. If you're a person with an anxiety disorder like me, it wouldn't hurt to take a look at the links below and make your own mental health diet (if you can) for a few months just to see if it might help.

Sources:
Nutritional Strategies to Ease Anxiety:
https://www.health.harvard.edu/blog/nutritional-strategies-to-ease-anxiety-201604139441

About Dr. Uma Naidoo:
https://www.health.harvard.edu/blog/author/unaidoo